Regence Innova Plan Highlights For Groups of 51+ 1/1/2018
|
|
- Alison Willa Griffith
- 6 years ago
- Views:
Transcription
1 Regence Innova Highlights Features Provider choice: Members have direct access to their choice of providers. Coinsurance levels are lowest for providers. If a member chooses a Category 3 provider, the member may be required to pay costs above the Category 3 allowed amount. Upfront benefits: Office visits are not subject to the deductible ( and 2 only). In addition, the first $400 of outpatient radiology and laboratory services per calendar year are not subject to the deductible. Additional benefits: Outpatient radiology and laboratory beyond the first $400 per calendar year, and all other professional services are subject to member deductible and coinsurance levels as specified below. Ambulatory Surgical Center: While many surgical procedures are best performed in a hospital setting, many can be safely and effectively performed in an Ambulatory Surgery Center (ASC) at a lower cost. A member may pay less out-of-pocket if a surgical procedure is performed at a ASC. For more information, or a list of services that can be performed at an ASC, contact Regence customer service. Telehealth visits (conducted via phone, secure online video, mobile app or web) for primary care services are available from and Category 2 providers, usually at lower out-of-pocket expense with providers. Calendar Year Deductible Applies to all covered expenses except where noted Individual deductible options per calendar year: $250, $500, $750, $1,000, $1,500, $2,000, $3,000, $4,000, $5,000 Family deductible is three times the individual amount except: $5,000 deductible option is two times the individual amount Calendar Year Out-of-Pocket Maximums Out-of-pocket maximum amount per calendar year, including deductible and copays, applies to all covered expenses, including prescription medications, except where noted. When the out-of-pocket maximum is reached, this plan provides benefits at 10 of the allowed amount for the remainder of the calendar year. Individual out-of-pocket maximum options per calendar year: $250 deductible option: $2,500, $3,500, $4,500, $7,150 $500 and $750 deductible option: $3,000, $4,000, $5,000, $7,150 $1,000 deductible option: $3,500, $4,500, $5,500, $7,150 $1,500 deductible option: $4,000, $5,000, $6,000, $7,150 $2,000 deductible option: $4,500, $5,500, $7,150 $3,000 deductible option: $5,500, $7,150 $4,000 and $5,000 deductible options: $7,150 Family out-of-pocket maximum is two times the individual amount Highlights - Group 51+ Regence Innova - RBS - January
2 Regence Innova Highlights MEMBER RESPONSIBILITY (Preferred) Category 2 (Participating) Category 3 (Non-contracted) Covered Services Upfront Office Visits and 2 not subject to deductible Options $20 / $35 Category 2 $30 / $45 Category 2 Preventive Care and Immunizations and 2: Not subject to deductible Upfront Outpatient Radiology and Laboratory First $400 per calendar year Professional Services/ Outpatient Radiology and Laboratory Office and inpatient services and supplies Category 2 Category 2 Category 2 Upfront Benefits Do Not Apply Category 3 Benefits Apply Upfront Benefits Do Not Apply Category 3 Benefits Apply Upfront Benefits Do Not Apply Category 3 Benefits Apply Ambulatory Surgical Center 5% Member may be responsible for any provider costs above the Category 3 allowed amount. Highlights - Group 51+ Regence Innova - RBS - January
3 Regence Innova Highlights MEMBER RESPONSIBILITY (Preferred) Category 2 (Participating) Category 3 (Non-contracted) Covered Services Hospital Services Inpatient and outpatient services and supplies Home Health 130 visits per calendar year Hospice Respite care limited to 14 days inpatient/outpatient per lifetime Maternity Rehabilitation Services Inpatient: 30 days per calendar year Outpatient: 25 visits per calendar year Skilled Nursing Facility 60 inpatient days per calendar year Acupuncture 12 visits per calendar year Highlights - Group 51+ Regence Innova - RBS - January
4 Regence Innova Highlights MEMBER RESPONSIBILITY (Preferred) Category 2 (Participating) Category 3 (Non-contracted) Covered Services Substance Use Disorder / Mental Health Services No benefit maximum Inpatient Outpatient Outpatient office / psychotherapy visits Other outpatient services Emergency Room Services $100 copay per ER visit (waived if directly admitted) Spinal Manipulations 10 spinal manipulations per calendar year Highlights - Group 51+ Regence Innova - RBS - January
5 Regence Innova Highlights Prescription Medication Coverage Prescription medication deductible options per calendar year: $0, $250, $500 Retail or Mail Order: up to 90-day supply (one copay per 30-day supply), including covered self-administrable injectable medications Specialty medications covered at participating retail pharmacies for first fill only. After first fill members use specialty pharmacies. Up to 30-day supply per fill. Deductible, copays and coinsurance apply to the out-of-pocket maximum Member may be balance billed when a nonparticipating pharmacy is used. If an equivalent generic medication is available and a brand-name medication is chosen, the member is responsible for paying the applicable brand-name copay/coinsurance plus the difference in price between the equivalent generic medication and the brand-name medication not to exceed total retail cost Three- Tier Option Generics: not subject to deductible $5 generic $25 brand-name formulary $50 brand-name non-formulary $7 generic 25% brand-name formulary 5 brand-name non-formulary $10 generic $35 brand-name formulary $75 brand-name non-formulary $10 generic 35% brand-name formulary 5 brand-name non-formulary Six-Tier Option Preferred Generics: not subject to deductible $5 preferred generic / 25% non-preferred generic $25 preferred brand-name / $50 non-preferred brand-name $150 preferred specialty / 5 non-preferred specialty $7 preferred generic / 25% non-preferred generic 25% non-preferred brand-name / 5 preferred brand-name 25% preferred specialty / 5 non-preferred specialty $10 preferred generic / 25% non-preferred generic $35 preferred brand-name / $75 non-preferred brand-name $150 preferred specialty / 5 non-preferred specialty $10 preferred generic / 25% non-preferred generic 35% preferred brand-name / 5 non-preferred brand-name 4 preferred specialty / 5 non-preferred specialty Highlights - Group 51+ Regence Innova - RBS - January
6 Regence Innova Highlights MEMBER RESPONSIBILITY Optional Benefits Available Spinal Manipulations Option with no benefit maximum Pre-Deductible Spinal Manipulations 10 spinal manipulations per calendar year Not subject to deductible Vision One routine eye exam per calendar year Hardware: Maximum benefit per calendar year - $150 for VSP Provider; $80 for VSPapproved wholesale vendor Not subject to deductible (Preferred) Category 2 (Participating) Category 3 (Non-contracted) Member may be responsible for any provider costs above the Category 3 allowed amount. Highlights - Group 51+ Regence Innova - RBS - January
7 Regence Innova Highlights Optional Program Available With All s Employee Assistance Program (EAP) Additional Information Outside the Service Area No cost to the member for: Up to four face-to-face sessions per incident to manage stress or work-life balance situations Legal and financial assistance 24/7 crisis line Members have the security of knowing they can access Blue Cross and/or Blue Shield (Blue ) providers across the country through the BlueCard Program and worldwide through BlueCross BlueShield Global Core Program. benefits apply as described within this document, and members may receive discounts on their services. Highlights - Group 51+ Regence Innova - RBS - January
8 Regence Innova Highlights General Medical Exclusions Coverage is not provided for any of the following, including direct complications or consequences that arise from: Cosmetic/Reconstructive Services and Supplies except for reconstruction for functional injury and disease, to treat a congenital anomaly, and for breast reconstruction following a medically necessary mastectomy to the extent required by law Counseling in the absence of illness is excluded unless required by law Custodial Care: Non-skilled care and helping with activities of daily living unless member is eligible for Palliative Care benefits Dental Examinations and Treatments Fees, Taxes, Interest: Charges for shipping and handling, postage, interest, or finance charges that a provider might bill; except sales taxes for durable medical equipment and mobility enhancing equipment Government Programs: Benefits that are covered, or would be covered in the absence of this plan, by any federal, state or governmental program Hearing Aids and Other Hearing Devices: Hearing aids (externally worn or surgically implanted) and other hearing devices are excluded. This exclusion does not apply to cochlear implants. Infertility: : Except to the extent covered services are required to diagnose such condition, treatment of infertility, including, but not limited to surgery and fertility drugs and medications is excluded Investigational Services: Treatment or procedures (health interventions) and services, supplies and accommodations provided in connection with investigational treatments or procedures Military Service Related Conditions: The treatment of any condition caused by or arising out of a member's active participation in a war or insurrection or conditions incurred in or aggravated during performance in the Uniformed Services Motor Vehicle Coverage and Other Insurance Liability Non-Direct Patient Care including appointments scheduled and not kept, charges for preparing medical reports, itemized bills or claim forms, and visits or consultations that are not in person (except as specifically allowed under the telemedicine and telehealth medical benefits) Obesity or Weight Reduction/Control: Treatment, medications, surgeries (including revisions, reversals, and treatment of complications), programs or supplies intended to result in or relate to weight reduction, regardless of diagnosis, unless required by law Orthognathic Surgery except for congenital conditions, temporomandibular joint disorder, injury, and sleep apnea Personal Comfort Items: Appliances or equipment primarily for comfort, convenience, cosmetics, environmental control, education or general physical fitness (e.g. televisions, telephones, air conditioners, air filters, humidifiers, whirlpools, heat lamps, weight lifting equipment, physical fitness programs, and therapy or service animals, including the cost of training and maintenance.) Physical Exercise Programs and Equipment including hot tubs or membership fees at spas, health clubs, or other facilities; applies even if the program, equipment, or membership is recommended by the member s provider Private Duty Nursing including ongoing shift care in the home Riot, Rebellion and Illegal Acts: Services and supplies for treatment of an illness, injury, or condition caused by a member s voluntary participation in a riot, armed invasion, or aggression, insurrection, or rebellion or sustained by a member while committing an illegal act or felony Highlights - Group 51+ Regence Innova - RBS - January
9 Regence Innova Highlights Routine Foot Care Routine Hearing Exams Self-Help, Self-Care, Training, or Instructional Programs including childbirth classes including infant care; and instruction programs, including those programs that teach a person how to use durable medical equipment or how to care for a family member Services and Supplies Provided by a Member of Member s Family Services and Supplies That Are Not Medically Necessary Services to Alter Refractive Character of the Eye Sexual Dysfunction: Treatment of sexual dysfunction, regardless of cause, including but not limited to devices, implants, and surgical procedures, and medications except for covered mental health services Third-Party Liability: Services and supplies for treatment of illness or injury for which a third party is or may be responsible Travel and Transportation Expenses other than covered ambulance services Work-Related Conditions except for subscribers and their dependents who are owners, partners, or corporate officers and are exempt from state or federal workers' compensation law This is a brief summary of benefits; it is not a certificate of coverage. All benefits must be medically necessary. For full coverage provisions, refer to the contract. Highlights - Group 51+ Regence Innova - RBS - January
Regence Classic Plan Highlights (Standard) For Groups of 51+ 1/1/2018
Plan Features Provider choice: Members have direct access to their choice of providers. Coinsurance levels are lowest for In- Network providers. If a member chooses an Out-of-Network provider, the member
More informationRegence Classic Plan Highlights (Standard) For Groups of 51+ 1/1/2019
Plan Features Provider choice: Members have direct access to their choice of providers. Coinsurance levels are lowest for In- Network providers. If a member chooses an Out-of-Network provider, the member
More informationRegence Engage Plan Highlights For Groups of /1/2019
Plan Features Provider choice: Members have direct access to their choice of providers. Category 1 are Preferred; Category 2 are Participating; and Category 3 are Non-contracted providers. Ambulatory Surgical
More informationRegence Preferred Plan Highlights For Groups of /1/2018
Regence Preferred Highlights Features Provider choice: Members have direct access to their choice of providers. Coinsurance levels are lowest for Category 1 providers. If a member chooses a Category 3
More informationRegence BluePoint 20/40 Plan Highlights For Groups of 51+ 1/1/2019
Plan Features Provider choice: Members have direct access to their choice of providers. Coinsurance levels are lowest for In- Network providers. If a member chooses an Out-of-Network provider, the member
More informationRegence HSA Healthplan 3.0 (Standard) Plan Highlights For Groups 51+ 1/1/2018
Plan Features The Regence HSA Healthplan 3.0 is a simple way to pay for life s medical expenses. Comprehensive health plan combined with a separate tax-free savings account provides a simple way to pay
More informationRegence Classic Plan Highlights (Standard) For Groups of 51+ 1/1/2019
Plan Features Provider choice: Members have direct access to their choice of providers. Coinsurance levels are lowest for In- Network providers. If a member chooses an Out-of-Network provider, the member
More informationRegence Classic Plan Highlights For Groups of /1/2017
Plan Features Provider choice: Members have direct access to their choice of providers. Coinsurance levels are lowest for In- Network providers. If a member chooses an Out-of-Network provider, the member
More informationRegence Innova Plan Highlights For Groups of 51+ 1/1/2019
Regence Innova Highlights Features Coinsurance levels are lowest for providers. If a member chooses a Category 3 provider, the member may be required to pay costs above the Category 3 allowed amount. Upfront
More informationAsuris Classic Plan Highlights (Standard) For Groups of 51+ 1/1/2019
Plan Features Provider choice: Members have direct access to their choice of providers. Coinsurance levels are lowest for In-Network providers. If a member chooses an Out-of-Network provider, the member
More informationRegence Innova Plan Highlights For Groups of /1/2016
Regence Innova Highlights Features Provider choice: Members have direct access to their choice of providers. Coinsurance levels are lowest for providers. If a member chooses a Category 3 provider, the
More informationRegence HSA Healthplan 3.0 (Standard) Plan Highlights For Groups 51+ 1/1/2019
Plan Features The Regence HSA Healthplan 3.0 is a simple way to pay for life s medical expenses. Comprehensive health plan combined with a separate tax-free savings account provides a simple way to pay
More informationRegence Preferred Plan Highlights For Groups of /1/2016
Regence Preferred Highlights Features Provider choice: Members have direct access to their choice of providers. Coinsurance levels are lowest for Category 1 providers. If a member chooses a Category 3
More informationRegence HSA Healthplan 3.0 (100%) Plan Highlights For Groups 51+ 1/1/2018
Plan Features The Regence HSA Healthplan 3.0 is a simple way to pay for life s medical expenses. Comprehensive health plan combined with a separate tax-free savings account provides a simple way to pay
More informationRegence BluePoint 20/40 Plan Highlights For Groups of /1/2016
Plan Features Provider choice: Members have direct access to their choice of providers. Coinsurance levels are lowest for In- Network providers. If a member chooses an Out-of-Network provider, the member
More informationAsuris HSA Healthplan 3.0 (Embedded) Plan Highlights For Groups of 51+ 1/1/2018
Plan Features The Asuris HSA Healthplan 3.0 is a simple way to pay for life s medical expenses. Comprehensive health plan combined with a separate tax-free savings account provides a simple way to pay
More informationAsuris HSA Healthplan 3.0 (100%) Plan Highlights For Groups of 51+ 1/1/2018
Plan Features The Asuris HSA Healthplan 3.0 is a simple way to pay for life s medical expenses. Comprehensive health plan combined with a separate tax-free savings account provides a simple way to pay
More informationAsuris HSA Healthplan 3.0 (Embedded) Plan Highlights For Groups of 51+ 1/1/2019
Plan Features The Asuris HSA Healthplan 3.0 is a simple way to pay for life s medical expenses. Comprehensive health plan combined with a separate tax-free savings account provides a simple way to pay
More informationRegence HSA Healthplan 3.0 (Embedded) Plan Highlights For Groups 51+ 1/1/2018
Plan Features The Regence HSA Healthplan 3.0 is a simple way to pay for life s medical expenses. Comprehensive health plan combined with a separate tax-free savings account provides a simple way to pay
More informationRegence ActiveCare Plan Highlights For Groups 51+ 1/1/17
Plan Features Subscribers choose their Coordinated Network. Coordinated Network means a network of providers who integrate clinically in managing members' care. Ambulatory Surgical Center: While many surgical
More informationAsuris HSA Healthplan 3.0 (100%) Plan Highlights For Groups 101+ Effective 1/1/17
Plan Features The Asuris HSA Healthplan 3.0 is a simple way to pay for life s medical expenses. Comprehensive health plan combined with a separate tax-free savings account provides a simple way to pay
More informationRegence BluePoint Benefit Highlights
Benefit Highlights 's features: Groups can choose from one of the following four networks for benefits: Participating Network, Preferred BlueOption Network, Preferred ValueCare Network, or Preferred FocalPoint
More informationRegence HSA Healthplan 3.0 (Standard) Plan Highlights For Groups 51+ 1/1/2015
Plan Features The Regence HSA Healthplan 3.0 is a simple way to pay for life s medical expenses. Comprehensive health plan combined with a separate tax free savings account provides a simple way to pay
More informationRegence HSA Healthplan 2.0 (100%) Plan Highlights For Groups of 51+ 1/1/2015
Plan Features The Regence HSA Healthplan 2.0 is a simple way to pay for life s medical expenses. Comprehensive health plan combined with a separate tax free savings account provides a simple way to pay
More informationRegence EmployeeChoice Plan Highlights Platinum+, Platinum, Gold 500, Gold+, Gold, Gold Simple, Silver, Silver Simple For Groups of /1/2015
Plan Features Provider choice: Member coinsurance levels are lowest for In-Network providers. If a member chooses an Out-of-Network provider, the member may be required to pay costs above the allowed amount.
More informationIn Network: $1,000 Out of Network: $3,000. In Network: $1,500 Out of Network: $3,500. In Network: $4,000 Out of Network: $5,000
Platinum+, Platinum, Gold+, Gold,, HSA, HSA+, HSA,, Plan Features Groups can choose from one of the following three networks for In Network benefits: Oregon Select Adventist, Oregon Select Tuality and.
More informationRegence HSA Individual Direct Plan Highlights Silver HSA, Bronze HSA 100 1/1/15
Plan Features Provider choice: Members have direct access to their choice of providers. Member coinsurance levels are lowest for In Network providers. If a member chooses an Out of Network provider, the
More informationRegence Evolve HSA Plan sm (50/50/50) Highlights
Regence BlueShield of Idaho Regence Evolve HSA Plan sm (50/50/50) Highlights The new Regence Evolve HSA Plan is a simple way to pay for life s medical expenses. It s a comprehensive/catastrophic health
More information2017 Regence Idaho. Individual cost shares details Benefit descriptions In network Out of network
Gold 1000 2017 Regence Idaho Annual deductible The total deductible you pay per calendar year $1,000 $5,000 Coinsurance The amount you pay after you meet your deductible 20% 50% $6,500 $200,000 1. Ambulatory
More informationIn-Network: $1,400 Out-of- Network: $1,400. In-Network: $750 Out-of- Network: $750. In-Network: $2,400 Out-of- Network: $5,000
Plan Features Provider choice: For In-Network benefits, members have direct access to their choice of providers within the Preferred network. Member coinsurance levels are lowest for In-Network providers.
More informationWhat is the overall deductible? Are there other deductibles for specific services?
Regence BlueShield: Innova Coverage Period: 08/01/2016 07/31/2017 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual and Eligible Family Plan Type: PPO This
More informationRegence BlueShield: Innova 2500 Coverage Period: 11/01/ /31/2017
Regence BlueShield: Innova 2500 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 11/01/2016 10/31/2017 Coverage for: Individual and Eligible Family Plan Type: PPO
More informationPHYSICIAN SERVICES. $30 copay 1 1 You pay 50% $40 copay. You pay 0% 1 You pay 50% INPATIENT SERVICES OUTPATIENT SERVICES
BENEFIT IN NETWORK OUT OF NETWORK This plan is intended to comply with the federal Patient Protection and Affordable Care Act. Provisions are subject to change as additional regulatory guidance becomes
More informationAn Overview of Your Health and Dental Benefits
An Overview of Your Health and Dental Benefits Educators Health Alliance Direct Bill Plan 2 \ EDUCATORS HEALTH ALLIANCE HEALTH AND DENTAL PLAN OPTIONS Exclusively for Educators Health Alliance Direct Bill
More informationTexas Open Access Value 7500/70%
Open Access Value 7500/70% BENEFIT IN NETWORK OUT OF NETWORK This plan is intended to comply with the federal Patient Protection and Affordable Care Act. Provisions are subject to change as additional
More informationCigna pays 50% of eligible charges Individual Out of Pocket Maximum $4,900 $12,500. Cigna pays 100% of eligible charges PHYSICIAN SERVICES
BENEFIT IN NETWORK OUT OF NETWORK This plan is intended to comply with the federal Patient Protection and Affordable Care Act. Provisions are subject to change as additional regulatory guidance becomes
More informationWhat is the overall deductible? Are there other deductibles for specific services? Is there an out-ofpocket
Regence BlueShield: Regence Direct Silver with Dental, Vision, Individual Assistance Program Coverage Period: Beginning on or after 01/01/2014 Summary of Benefits and Coverage: What this Plan Covers &
More informationIn-network: $5,000 single / $10,000 family per calendar year. Out-of-network: $10,000 per insured per
Regence BlueShield: Regence Direct Bronze HSA Coverage Period: Beginning on or after 01/01/2014 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual & Eligible
More informationRegence BlueCross BlueShield of Oregon: Preferred Plan A $500 Coverage Period: 01/01/ /31/2017
Regence BlueCross BlueShield of Oregon: Preferred Plan A $500 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2017 12/31/2017 Coverage for: Individual & Eligible
More informationSchedule of Benefits Summary Group Name: Nebraska Bankers Association VEBA Effective Date: January 01, 2018
Schedule of Benefits Summary Group Name: Nebraska Bankers Association VEBA Effective Date: January 01, 2018 Payment for Services Covered Services are reimbursed based on the Allowable Charge. Blue Cross
More informationRegence BlueCross BlueShield of Oregon: Preferred Coverage Period: 07/01/ /31/2016
Regence BlueCross BlueShield of Oregon: Preferred Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 07/01/2016 12/31/2016 Coverage for: Individual & Eligible Family
More informationBlue Cross Select Silver 94 Blue Cross Preferred Silver 94
Blue Cross Select Silver 94 Blue Cross Preferred Silver 94 An individual HMO health plan from Blue Care Network of Michigan. Blue Cross Select You may choose from a select network of quality primary care
More informationRegence BlueShield: Choice HSA 1500 Coverage Period: 01/01/ /31/2016
Regence BlueShield: Choice HSA 1500 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2016-12/31/2016 Coverage for: Individual & Eligible Family Plan Type:
More informationRegence BlueShield: Regence Gold 1000 Preferred
Regence BlueShield: Regence Gold 1000 Preferred Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2016 12/31/2016 Coverage for: Individual & Eligible Family
More informationOpen Access Value 2500A/70%
BENEFIT IN NETWORK OUT OF NETWORK This plan is intended to comply with the federal Patient Protection and Affordable Care Act. Provisions are subject to change as additional regulatory guidance becomes
More informationShort-Term PPO Plans. Individual and Family Health Care Plans for California
Short-Term PPO Plans Individual and Family Health Care Plans for California Could This Be You? Our Short-Term Plans are Long on Benefits...for You! You can depend on our experience we ve been helping people
More informationBlue Precision Platinum HMO 004 OUTLINE OF COVERAGE
Blue Precision Platinum HMO 004 Blue Precision HMO SM Network OUTLINE OF COVERAGE 1. READ YOUR POLICY CAREFULLY. This outline of coverage provides a brief description of the important features of your
More informationRegence BlueCross BlueShield of Utah: Regence HSA 3.0 SM Coverage Period: 12/01/ /30/2016
Regence BlueCross BlueShield of Utah: Regence HSA 3.0 SM Coverage Period: 12/01/2015 11/30/2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual & Eligible
More informationAnthem Blue Cross Effective: January 1, 2018 Your Plan: University of California UC Care Plan Your Network: UC Select and Anthem Preferred
Anthem Blue Cross Effective: January 1, 2018 Your Plan: University of California UC Care Plan Your Network: UC Select and Anthem Preferred This summary of benefits is a brief outline of coverage, designed
More informationILLINOIS SHORT-TERM PLANS. Immediate Coverage to Meet the Needs of Individuals and Families. UniCare is a WellPoint Company
ILLINOIS SHORT-TERM PLANS Immediate Coverage to Meet the Needs of Individuals and Families UniCare is a WellPoint Company The UniCare Difference Who We Are UniCare Health Insurance Company of the Midwest
More informationFull PPO Combined Deductible /60 Benefit Summary (For groups of 101 and above) (Uniform Health Plan Benefits and Coverage Matrix)
An independent member of the Blue Shield Association Full PPO Combined Deductible 25-250 90/60 Benefit Summary (For groups of 101 and above) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield
More informationBenefit modifications for members with Full PPO /60
An independent licensee of the Blue Shield Association A17436 (01/2017) Benefit modifications for members with Full PPO 250 80/60 Effective January 1, 2017 The Full PPO 250 80/60 plan name will be changed
More informationRegence HDHP-1 with Alternative Care Coverage Period: 01/01/ /31/2017
Regence HDHP-1 with Alternative Care Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2017-12/31/2017 Coverage for: Individual & Eligible Family Plan Type:
More informationWhat is the overall deductible?
Regence BlueCross BlueShield of Utah: HSA 3.0 Coverage Period: 04/01/2013-03/31/2014 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual & Eligible Family Plan
More informationMaximums Note: Out-of-Pocket maximum is the amount of covered expenses that you and/or your covered dependents will pay.
PRIORITY HEALTH priorityhealth.com PRIORITYHMO SUMMARY OF BENEFITS 100% HOSPITAL PLAN State of Michigan Active Plan October 14, 2012 - October 13, 2013 The following information is provided as a summary
More informationRegence BlueShield: Engage 70 Coverage Period: 11/01/ /31/2017
Regence BlueShield: Engage 70 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 11/01/2016 10/31/2017 Coverage for: Individual and Eligible Family Plan Type: PPO
More informationSUMMARY OF BENEFITS. Cigna Health and Life Insurance Co.
SUMMARY OF BENEFITS Ohio Associated Enterprises Health Savings Account Open Access Plus www.mycigna.com Member Services: (866) 494-2111 Cigna Health and Life Insurance Co. General Services In-Network Out-of-Network
More informationRegence BlueShield of Idaho: Regence HSA Healthplan 2.0 SM Coverage Period: [MM/DD/YYYY MM/DD/YYYY]
Regence BlueShield of Idaho: Regence HSA Healthplan 2.0 SM Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: [MM/DD/YYYY MM/DD/YYYY] Coverage for: Individual & Eligible
More informationAnthem Blue Cross Your Plan: Premier HMO 10/100% - MUST Trust Your Network: California Care HMO
Anthem Blue Cross Your Plan: Premier HMO 10/100% - MUST Trust Your Network: California Care HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection process.
More informationINDIVIDUAL & FAMILY PLANS
BENEFIT IN NETWORK OUT OF NETWORK This plan is intended to comply with the federal Patient Protection and Affordable Care Act. Provisions are subject to change as additional regulatory guidance becomes
More informationMEDICAL SCHEDULE OF BENEFITS COPAY GOLD
NON- LIFETIME MAXIMUM BENEFIT Unlimited CALENDAR YEAR MAXIMUM BENEFIT CALENDAR YEAR DEDUCTIBLE Single Family CALENDAR YEAR OUT-OF-POCKET MAXIMUM (includes Deductible, Coinsurance, Copays and Precertification
More informationRegence BlueShield : HSA 2.0
Regence BlueShield : HSA 2.0 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 10/01/2016-09/30/2017 Coverage for: Individual and Eligible Family Plan Type: PPO This
More informationBlue Cross Silver, a Multi-State Plan 94
Blue Cross Silver, a Multi-State Plan 94 An individual PPO health plan from Blue Cross Blue Shield of Michigan. You will have a broad choice of doctors and hospitals within BCBSM s unsurpassed statewide
More informationMEDICAL SCHEDULE OF BENEFITS COPAY GOLD
LIFETIME MAXIMUM BENEFIT Unlimited CALENDAR YEAR MAXIMUM BENEFIT CALENDAR YEAR DEDUCTIBLE Single Family CALENDAR YEAR OUT-OF-POCKET MAXIMUM (includes medical Deductible, medical Coinsurance, medical Copays
More informationBlue Cross Silver, a Multi-State Plan 87
Blue Cross Silver, a Multi-State Plan 87 An individual PPO health plan from Blue Cross Blue Shield of Michigan. You will have a broad choice of doctors and hospitals within BCBSM s unsurpassed statewide
More informationBlue Precision Silver HMO 106 Blue Precision HMO SM
Blue Precision Silver HMO 106 Blue Precision HMO SM OUTLINE OF COVERAGE 1. READ YOUR POLICY CAREFULLY. This outline of coverage provides a brief description of the important features of your Policy. This
More informationAnthem Blue Cross Your Plan: Anthem Elements Choice HMO 1500 (Essential Formulary $5/$20/$50/$65/30% $500 Deductible) Your Network: Select HMO
Anthem Blue Cross Your Plan: Anthem Elements Choice HMO 1500 (Essential Formulary $5/$20/$50/$65/30% $500 Deductible) Your Network: Select HMO This summary of benefits is a brief outline of coverage, designed
More informationMEDICAL SCHEDULE OF BENEFITS COPAY GOLD
LIFETIME MAXIMUM BENEFIT CALENDAR YEAR MAXIMUM BENEFIT CALENDAR YEAR DEDUCTIBLE Single Family CALENDAR YEAR OUT-OF-POCKET MAXIMUM (includes medical Deductible, medical Coinsurance, medical Copays and Precertification
More informationARIZONA. CIGNA health savings plans. Health and Pharmacy Benefits c AZ 07/ CIGNA
ARIZONA Individual & Family Plans CIGNA health savings plans Health and Pharmacy Benefits PLAN comparison 820521c AZ 07/10 2010 CIGNA CIGNA HealthCare plans, offered through Connecticut General Life Insurance
More informationNot applicable. Immunizations 1 exam per 12 months for members age 18 to age 65; 1 exam per 12 months for adults age 65 and older.
PLAN FEATURES NON- Deductible (per calendar year) $300 Employee $600 Employee $900 Family $1,800 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. Once Family
More informationOUTLINE OF COVERAGE. Blue Choice PPO Bronze 005
OUTLINE OF COVERAGE 1. READ YOUR POLICY CAREFULLY. This outline of coverage provides a brief description of the important features of your Policy. This is not the insurance contract, and only the actual
More informationBlueSecure Plus HMO Plan Benefit Summary
BlueSecure Plus HMO Plan Benefit Summary This plan is available for issuance effective October 1, 2008 Network Providers Except for emergencies, all covered services must be rendered by a network provider.
More informationWhat is the overall deductible?
Regence BlueShield of Idaho: Preferred Coverage Period: 09/01/2016-08/31/2017 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual & Eligible Family Plan Type:
More information40% (Not subject to the Calendar-Year Deductible) CT scans, MRIs, MRAs, PET scans, and cardiac diagnostic
An independent member of the Blue Shield Association P.C. Specialists dba Technology Integration Group Custom Shield PPO Combined Deductible 30-1250 90/60 Benefit Summary (For groups of 300 and above)
More informationThis is an ERISA plan, and you have certain rights under this plan. Please contact your Employer for additional information.
Schedule of Benefits Employer: Rider University ASA: 884014 Issue Date: January 2, 2013 Effective Date: January 1, 2013 Schedule: 1E Booklet Base: 1 For: Choice POS II (Aetna Choice POS II) Safety Net
More informationBlue Shield of California. Highlights: A description of the prescription drug coverage is provided separately
An independent member of the Blue Shield Association California Trucking Association Health & Welfare Trust Access+ HMO SaveNet Facility Coinsurance 25-25% Benefit Summary (For groups of 300 and above)
More informationSummary of Benefits Prominence HealthFirst Small Group Health Plan
HealthFirst/ Calendar Year Deductible (CYD) 2 $1,000 Single / $3,000 Family Summary of Benefits $3,000 Single / $9,000 Family Coinsurance - Member responsibility 30% coinsurance 50% coinsurance Out-of-Pocket
More informationand cardiac diagnostic procedures utilizing nuclear medicine) Bariatric surgery Not Covered Not Covered
An independent member of the Blue Shield Association Wesco Aircraft ASO PPO Benefit Summary (For groups of 300 and above) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective:
More informationChanges in some state or federal law or regulations or interpretations thereof may change the terms and conditions of coverage.
BlueCare Direct Silver SM 212 with Advocate BlueCare Direct SM OUTLINE OF COVERAGE 1. READ YOUR POLICY CAREFULLY. This outline of coverage provides a brief description of the important features of your
More informationAnthem Blue Cross Your Plan: Modified Premier HMO 15/100% (Essential formulary $5/$15/$25/$45/30%) Your Network: California Care HMO
Anthem Blue Cross Your Plan: Modified Premier HMO 15/100% (Essential formulary $5/$15/$25/$45/30%) Your Network: California Care HMO This summary of benefits is a brief outline of coverage, designed to
More informationCost if you use a Non-Network Provider. Cost if you use an In-Network Provider. Covered Medical Benefits
Anthem Blue Cross California State University Risk Management Authority Your Plan: Custom Premier HMO 20/200 admit/100 OP (Custom Rx $5/$20/$60/20%) Your Network: California Care HMO This summary of benefits
More informationPLAN DESIGN & BENEFITS. $100 Individual/$200 Family $500 Individual/$1000 Family
PLAN FEATURES Deductible (per calendar year) Provider None $1000 Individual/$2000 Family Deductible (per calendar year) Facility Level A: Level B: $100 Individual/$200 Family $500 Individual/$1000 Family
More informationB l u e O p t i o n s F o r A d u l t s, F a m i l i e s, a n d C h i l d r e n
2011 BlueOptions For Adults, Families, and Children BCP2808BR12/10 When choosing a health plan the first thing you want is plenty of choices. While that seems obvious, not every insurance company offers
More informationBalance 3 up to Allowed Amount 4 after BCBSF pays up to $50. $0 CYD % Coinsurance 6
Understanding Your Share for Covered Services This health insurance policy 1 provides you with routine health care services, such as physician office services, as well as basic protection against major
More informationSUMMARY OF BENEFITS. Cigna Health and Life Insurance Co. RADCO Open Access Plus - Plan 1
SUMMARY OF BENEFITS Cigna Health and Life Insurance Co. RADCO Open Access Plus - Plan 1 General Services In-Network Out-of-Network Physician office visit Primary Care Physician (PCP) Physician Office Visit
More informationEffective: July 1, Highlights: A description of the prescription drug coverage is provided separately. Participating Providers 1
High Desert & Inland Trust Custom PPO 3 Benefit Summary (For groups of 300 and above) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective: July 1, 2016 THIS MATRIX IS
More informationSummary of Benefits Prominence HealthFirst Small Group Health Plan
Prominence Nevada Gold A Plus In-Network Calendar Year Deductible (CYD) 2 $1,000 Single / $3,000 Family Summary of Benefits $2,000 Single / $6,000 Family Coinsurance - Member responsibility 20% coinsurance
More informationWhat is the overall deductible?
Regence BlueShield of Idaho: Evolve Core Coverage Period: 07/01/2013 06/30/2014 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual & Eligible Family Plan Type:
More informationMEDICAL SCHEDULE OF BENEFITS HDHP $1350 PLAN
NON- LIFETIME MAXIMUM BENEFIT CALENDAR YEAR MAXIMUM BENEFIT Unlimited Unlimited CALENDAR YEAR DEDUCTIBLE (combined with Prescription Drug Card Deductible) Single $1,350 $2,500 Family $2,700* $5,000* *Note:
More informationImportant Questions Answers Why this Matters: For in-network providers: $11,000 Individual $22,000 Family of 2 or more
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.uhealthplan.utah.edu/burton-lumber/or by calling 1-888-271-5870.
More informationPLAN DESIGN AND BENEFITS - NYC Community Plan SM 6-11 PARTICIPATING PROVIDER REFERRED*
Aetna Health Inc. for Referred Benefits Plan Effective Date: 10/1/2011 PLAN FEATURES Deductible (per calendar ) $5,000 Individual $15,000 Family Unless otherwise indicated, the Deductible must be met prior
More informationWhat is the overall deductible? Are there other deductibles for specific services? Is there an out-ofpocket
Regence BlueCross BlueShield of Oregon: Preferred Coverage Period: 12/01/2014-12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual & Eligible Family
More information(30- to 34-day supply) 100% after $40 copay; significant or new therapeutic class drugs: 50%
C O U N T Y S I N T R A N E T S I T E : H T T P : / / I N T R A N E T. C O. R I V E R S I D E. C A. U S 25 Exclusive Care Select Medicare Coordination Plan Tier 1: Exclusive Care Network Tier 2: Any Provider
More informationMEDICAL SCHEDULE OF BENEFITS HDHP $4,000 PLAN
MEDICAL SCHEDULE OF BENEFITS HDHP $4,000 PLAN HDHP 4000 LIFETIME MAXIMUM BENEFIT CALENDAR YEAR MAXIMUM BENEFIT Unlimited Unlimited CALENDAR YEAR DEDUCTIBLE (combined with Prescription Drug Card Deductible)
More informationYour Plan: 2018 HMO Plan (2940) Your Network: California Care HMO
Anthem Blue Cross Your Plan: 2018 HMO Plan (2940) Your : California Care HMO ACWA JPIA C00361 This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This
More informationAetna Select Medical Plan PLAN FEATURES NETWORK OUT-OF-NETWORK. Plan Maximum Out of Pocket Limit excludes precertification penalties.
Schedule of Benefits Employer: Yale University ASA: 877076 Issue Date: July 25, 2016 Effective Date: January 1, 2016 Schedule: 12D Booklet Base: 12 For: Aetna Select - Security Staff (Outside CT) Electing
More informationAnthem Blue Cross Your Plan: Custom Classic HMO 20/250 Admit (Rx $15/$30/$45/$45) Your Network: Select HMO
Anthem Blue Cross Your Plan: Custom Classic HMO 20/250 Admit (Rx $15/$30/$45/$45) Your Network: Select HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection
More information2018 Medical Comparison Guide
2018 Medical Comparison Guide This and the following pages contain a limited description of the benefit coverage available through this group plan. Coverage is governed at all times by the complete terms
More informationBRONZE PPO PLAN BENEFIT SUMMARY
BRONZE PPO PLAN BENEFIT SUMMARY All benefits are subject to eligibility, maximum Plan benefit, reasonable and customary determination (or negotiated fee amounts for PPO provider services), and any special
More informationSUPPLEMENT TO BROWN UNIVERSITY STUDENT HEALTH INSURANCE PROGRAM SUMMARY BROCHURE
SUPPLEMENT TO 2017-2018 BROWN UNIVERSITY STUDENT HEALTH INSURANCE PROGRAM SUMMARY BROCHURE This Supplement is designed to clarify additional specific benefits outlined in the Summary Brochure while the
More information